Relevance. Surgical treatment of severe senior patients with defects of aortal valve and LV dysfunction, presence of combined IHD, other concomitant pathology, is a difficult task due to high risk of lethal outcome. Objective. To conduct and to present results of analysis of immediate and remote results of surgical treatment of patients with aortal defects complicated by severe systolic dysf unction (LV EF<35 %). Materials and methods. The analysis of immediate and remote surgical therapy results of patients with aortal defects and intense LV systolic dysf unction (EF lower than 35 %) in he period from January 2005 to July 2011. The study included 44 patients to whom correction of aortal defect was done. In order to improve surgery results we have been used a targeted protocol of pre and post surgery care. This protocol regulates the preventive preparation in the intensive care unit with application of Levosimendan, kidney replacement therapy in the post-operative period and usage of the hybrid approach in patients who have a combination of valvular disease with IHD. Results. Hospital mortality rate made 4.5 %. Survival rate in 1, 3 and 5 years made 92.7, 89.5 and 71.2 %, respectively. Conclusion. Surgical therapy of patients with aortal defects, complicated by expressed LV systolic dysfunction is the only effective method allowing obtaining encouraging results at low level of hospital mortality rate, spurred by the protocol of the perioperational maintenance of this especially severe category of patients.